Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia.
Department of High-Risk Pregnancies, University Clinic for Gynecology and Obstetrics "Narodni Front", Kraljice Natalije 62, 11000 Belgrade, Serbia.
Medicina (Kaunas). 2023 Feb 19;59(2):406. doi: 10.3390/medicina59020406.
: Monitoring pregnancies with fetal growth restriction (FGR) presents a challenge, especially concerning the time of delivery in cases of early preterm pregnancies below 32 weeks. The aim of our study was to compare different diagnostic parameters in growth-restricted preterm neonates with and without morbidity/mortality and to determine sensitivity and specificity of diagnostic parameters for monitoring preterm pregnancies with early preterm fetal growth restriction below 32 weeks. : Our clinical study evaluated 120 cases of early preterm deliveries, with gestational age ≤ 32 + 0 weeks, with prenatally diagnosed placental FGR. All the patients were divided into three groups of 40 cases each based on neonatal condition,: I-Neonates with morbidity/mortality (NMM); II-Neonates without morbidity with acidosis/asphyxia (NAA); III-Neonates without neonatal morbidity/acidosis/asphyxia (NWMAA). : Amniotic fluid index (AFI) was lower in NMM, while NWMAA had higher biophysical profile scores (BPS). UA PI was lower in NWMAA. NWMAA had higher MCA PI and CPR and fewer cases with CPR <5th percentile. NMM had higher DV PI, and more often had ductus venosus (DV) PI > 95th‱ or absent/reversed A wave, and pulsatile blood flow in umbilical vein (UV). The incidence of pathological fetal heart rate monitoring (FHRM) was higher in NMM and NAA, although the difference was not statistically significant. ROC calculated by defining a bad outcome as NMM and a good outcome as NAA and NWMAA showed the best sensitivity in DV PIi. ROC calculated by defined bad outcome in NMM and NAA and good outcome in NWMAA showed the best sensitivity in MCA PI. : In early fetal growth restriction normal cerebral blood flow strongly predicts good outcomes, while pathological venous blood flow is associated with bad outcomes. In fetal growth restriction before 32 weeks, individualized expectant management remains the best option for the optimal timing of delivery.
监测存在胎儿生长受限（FGR）的妊娠具有挑战性，尤其是在 32 周之前的极早早产妊娠中，分娩时机的选择尤其困难。我们的研究目的是比较有和无发病率/死亡率的生长受限早产儿之间的不同诊断参数，并确定用于监测早发性 32 周以下胎儿生长受限的早产妊娠的诊断参数的敏感性和特异性。
我们的临床研究评估了 120 例早发性早产分娩病例，胎龄≤32+0 周，产前诊断为胎盘 FGR。所有患者均根据新生儿情况分为 3 组，每组 40 例：I-有发病率/死亡率的新生儿（NMM）；II-无发病率但有酸中毒/窒息的新生儿（NAA）；III-无新生儿发病率/酸中毒/窒息的新生儿（NWMAA）。
NMM 的羊水指数（AFI）较低，而 NWMAA 的生物物理评分（BPS）较高。NWMAA 的脐动脉搏动指数（UA PI）较低。NWMAA 的大脑中动脉搏动指数（MCA PI）和脐动脉收缩期峰值/舒张末期比值（CPR）较高，而 CPR<第 5 百分位数的情况较少。NMM 的静脉导管搏动指数（DV PI）较高，且更常出现 DV PI>第 95 百分位数或无/反向 A 波以及脐静脉（UV）搏动性血流。尽管差异无统计学意义，但 NMM 和 NAA 的病理性胎儿心率监测（FHRM）发生率更高。通过将不良结局定义为 NMM，将良好结局定义为 NAA 和 NWMAA，计算 ROC 显示 DV PIi 的敏感性最佳。通过将不良结局定义为 NMM 和 NAA，将良好结局定义为 NWMAA，计算 ROC 显示 MCA PI 的敏感性最佳。
在早期胎儿生长受限中，正常脑血流强烈预示着良好的结局，而病理性静脉血流与不良结局相关。在 32 周之前的胎儿生长受限中，个体化期待治疗仍然是选择最佳分娩时机的最佳选择。
